injury depends on the temperature, duration of exposure, skin thickness, tissue
conductance and specific heat of the causative agent; a burn-induced
inflammatory response that is not limited to the local burn wound is elicited.
This can lead to a massive systemic release of inflammatory mediators
inducing a significant burden on the respiratory, renal and gastrointestinal
systems.
Infants and children have a relatively large body surface area (BSA) per unit
of body weight than adults. This body surface area: body weight relationship is
maintained until the child reaches approximately 15 years of age. The
disproportionately thin skin in young children (< 2 years old) accounts for full
thickness injuries following heat exposure that would otherwise produce partial-
thickness burns in older patients. For example, exposure to temperatures of
130 oF (54oC) produces severe tissue destruction in just ten seconds in children
whereas exposure to this temperature in adults requires 20 seconds to produce
burn injury. Temperatures of 140oF (60oC), a common setting for home water
heaters, can cause tissue destruction in 5 seconds or less. Full thickness
burns are almost instantaneous with temperatures exceeding 170oF (77oC).
II. Initial EvaluationAll patients should be treated as trauma patients, following ATLS protocol.
Patients must be removed from the thermal source of injury; those suffering